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NUR 502 > Cardio (Complete) > Flashcards

Cardio (Complete) Flashcards

(57 cards)

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1
Q

Mediastinum Structure

A

Heart
Great vessels

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2
Q

Types of Great Vessels

A

-Aorta
-Pulmonary artery
-Superior vena cava
-Inferior vena cava

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3
Q

Where is Point of maximal impulse (which ventricle)

A

Left ventricle

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4
Q

Pericardium: Layers of the heart

A

Endocardium
Myocardium
Epicardium

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5
Q

Heart Valves _____

A

Unidirectional
Prevents backflow
Open and close passively

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6
Q

Atrioventricular valves (AV) Types and Location

A

Tricuspid Valve- Between the right atrium and the right ventricle of the heart
Mitral valve- Between the left atrium and the left ventricle of the heart

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7
Q

Semilunar Valves (SL) Types and location

A

Aortic- between the left ventricle and the aorta
Pulmonic valve- between right ventricle and the pulmonary artery

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8
Q

What happens during…Diastole (AV)

A

valves are open, filling phase-ventricles fill with
blood

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9
Q

What happens during..Systole (AV)

A

valves are closed, pumping phase-prevents blood
from backing into the aorta (regurgitation)

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10
Q

What happens during…Systole (SL)

A

valves are open, pumping phase-blood is ejected from
the heart

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11
Q

What happens during…Diastole (SL)

A

valves are closed, ventricles are relaxed, pressure
inside drops, preventing blood from flowing back into the heart

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12
Q

No valves are present between vena cava and right atrium, or
between pulmonary veins and left atrium which means…..(physiology)

A

-Abnormally high pressure in left side of heart gives a person symptoms of pulmonary congestion.
-Abnormally high pressure in right side of heart shows in neck veins and abdomen.

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13
Q

Deoxygenated Blood flow- Where does it enter from?

A

Enters the heart through the superior vena cava from the
upper body and the inferior vena cava from the lower body

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14
Q

Deoxygenated blood flow- First chamber of the heart

A

R atrium

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15
Q

Deoxygenated blood- First valve

A

Tricuspid valve: opens, blood flows from right atrium to the right ventricle

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16
Q

Deoxygenated blood- Second chamber of heart

A

R ventricle -contracts and pumps the blood to the lungs

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17
Q

Deoxygenated blood- second valve

A

Pulmonary valve- opens, blood flows from the right
ventricle to the pulmonary artery

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18
Q

Blood becoming oxygenated…
First artery

A

Pulmonary artery- Pulmonary artery carries the deoxygenated blood to the
lungs

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19
Q

Oxygenated blood flow- Returns to the heart through the ______ veins

A

Pulmonary veins

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20
Q

Blood goes through the pulmonary veins and
enters the _____

A

Left atrium

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21
Q

oxygenated blood flows from the left atrium
into the _____

A

Left Ventricle

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22
Q

Left ventricle: pumps the oxygenated blood to the ____

A

Aorta

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23
Q

What is the cardiac cycle?

Study These Flashcards
A

movement of blood through the heart

24
Q

Two phases of the cardiac cycle: Systole (what is happening physiologically)

Study These Flashcards
A

Systole
 Contraction of the heart
 Blood is pumped from the ventricles and fills the pulmonary
and systemic arteries.
 Represents one third of the cardiac cycle

…..Ventricular pressure becomes higher than that in atria
 Mitral and tricuspid valves close
 Closure of AV valves contributes to first heart sound (S1)
and signals beginning of systole
 AV valves close to prevent any regurgitation of blood back
up into atria during contraction
 Brief moment, all four valves are closed and ventricular
walls contract
 Contraction against closed systembuilds pressure in the
ventricles
 pressure in ventricles exceeds pressure in the aorta

25
Two phases of the cardiac cycle: Diastole (what is happening physiologically)
 Ventricles relax and fill with blood  Represents two-thirds of the cardiac cycle Ventricles relaxed  Tricuspid and mitral valves are open  Pressure in atria higher than that in ventricles, so blood pours rapidly into ventricles  Toward end of diastole, atria contract and push last amount of blood into ventricles
26
Types of heart sounds (basic overview)
normal heart sounds and, occasionally, extra heart sounds and murmurs
27
S1 heart sound
Occurs when AV valves close (beginning of systole)  Can hear S1 over all precordium, but loudest at apex
28
S2 heart sounds
Occurs when semilunar valves close  Signals end of systole  Heard over all of precordium, S2 loudest at base
29
S3
S3 occurs when ventricles resistant to filling during early rapid filling phase  Normally diastole is silent event  Occurs immediately after S2, when AV valves open and atrial blood first pours into ventricles  However, in some conditions, ventricular filling creates vibrations that can be heard over chest
30
S4
S4 Occurs at end of diastole, when ventricle resistant to filling  Atria contract and push blood into noncompliant ventricle  This creates vibrations that are heard as S4  S4 occurs just before S1
31
Stenotic murmer
 Valve opening progressively decreases in size  Forward flow of blood is restricted  Affected chamber becomes hypertrophied
31
Valvular heart disease
Result of turbulent blood flow  Gentle, blowing, whooshing or swishing sound heard  Causes a specific murmur, either systolic or diastolic
32
Heart Murmurs (forward and backwards)
FORWARD flow of blood through stiff stenotic OPEN valves  BACKWARD flow of blood through incompetently CLOSED valves
32
Regurgitation murmer
 Insufficiency or incompetent  Valve does not completely close  Backflow into chamber, causing overload and dilated chamber
33
Heart murmur locations
 Aortic Area: Right 2nd ICS  Pulmonic Area: Left 2nd ICS  Erb’s point 3rd Left ICS  Tricuspid Area: 4-5th ICS Left Sternal Border  Mitral Area: 5th ICS MCL
34
How are heart sounds described?
 Timing: systolic or diastolic  Duration: short or long  Location: where is it the loudest, radiates  Position patient: left lateral decubitus or sitting up  Shape: crescendo, decrescendo, or holosystolic  Grading and Intensity  Pitch (low, medium, or high)  Quality: blowing, harsh, rumbling, or musical
35
Properties of Cardiac cells
 Automaticity: the ability to initiate an impulse spontaneously and continuously.  Excitability: the ability to be electrically stimulated.  Conductivity: the ability to transmit an impulse along a membrane in an orderly manner.  Contractility: the ability to respond mechanically to an impulse.
36
Cardiac output (how much?) (Equation?)
4-6 liters HR X stroke volume
37
Stroke volume (output and definition)
(50 – 100 mL)  Volume of blood ejected with each heartbeat, and it is  Dependent on preload, myocardial contractility, and afterload.
37
Preload
Volume of blood in the ventricles at the end of diastole  Stretching of the cardiac cells prior to contraction Preload is venous return, which builds during diastole  How well ventricular muscle can stretch at end of diastole  According to Frank-Starling law, the greater the stretch, the stronger the heart’s contraction  This increased contractility results in an increased volume of blood ejected, increased stroke volume
38
Ejections fraction (percentage and definition)
50-70%  Percentage of blood ejected during each heartbeat
39
Mayocardial contractibility
Ability of the heart to contract  Maximum force of contraction a heart can achieve.
40
Afterload
 Force against which the heart has to contract to eject the blood.  Degree of vascular resistance which the left ventricle must pump (contraction) Afterload is the opposing pressure that the ventricle must generate to open aortic valve  Afterload is the resistance against which ventricle must pump its blood  After aortic valve opens, rapid ejection occurs
41
Developmental Considerations: Infants and Children
 Fetal heart begins to beat after 3 weeks’ gestation  Right and left ventricles equal in weight and muscle wall thickness and both pumping into systemic circulation  Inflation and aeration of lungs at birth produces circulatory changes  Now blood is oxygenated through lungs rather than through placenta  Now left ventricle has greater workload of pumping into systemic circulation
42
Heart rates for children at rest
Age (Yrs.) Avg. Rate Range 1-2 110-120 88-155 2-6 100-110 65-140 6-10 75-90 52-130
43
Developmental Considerations: Pregnancy
Blood volume increases by 30% to 40% during pregnancy  Most rapid expansion occurs during second trimester  Creates an increase in stroke volume and cardiac output and an increased pulse rate of 10 to 15 beats per minute  Despite increased cardiac output, arterial blood pressure decreases in pregnancy as a result of peripheral vasodilation  Blood pressure drops to lowest point during second trimester, then rises after that  Blood pressure varies with person’s position
44
Developmental Considerations: Aging Adult (12 points)
Lifestyle: diet, exercise, alcohol, smoking, drug use, and stress have an influence on coronary artery disease  Lifestyle affects the aging process; cardiac changes once thought to be due to aging due to sedentary lifestyle accompanying aging Systolic BP increases: thickening and stiffening of the arteries  Diastolic BP: decreases or no change  Left ventricular wall becomes thicker, usually the size of the heart does not change  No change in resting heart rate or cardiac output at rest  Decreased ability of heart to adjust cardiac output with exercise  Amount of collagen in the heart increases and elastin decreases.  Changes affect the contractile and distensible properties of the myocardium  Heart valves become thick and stiff  Increased need for pacemakers  SA node fails  Risk of orthostatic hypotension  Increase incidence of CAD, HTN, and HF
45
Cardiad assessment: Inspection
General appearance and vital signs  Skin color, temperature  Edema  Diaphoresis  Blood pressure: normal range  Extremities: perfusion  Pulses: brisk and easily palpable  JVP: normal range  Lower extremities for edema
46
Palpation: Carotid Artery
 Carotid artery is a central artery  Palpate the carotid pulse, including the carotid upstroke, its amplitude and contour, and the presence or absence of thrills.  Close to heart; timing closely coincides with ventricular systole (beginning of S1)  Located in groove between trachea and sternomastoid muscle, medial to and along-side that muscle  Carotid artery provides information about cardiac function  Aortic valve stenosis and regurgitation.  Palpate each medial to sternomastoid muscle  Palpate for carotid upstroke, amplitude and contour, and the presence or absence of thrills.  Height of pulsations unchanged by position  Height of pulsations not affected by inspiration  Avoid excessive pressure Patient should be supine with the head of the bed elevated to about 30°.  Inspect the neck for carotid pulsations  Often visible just medial to the sternomastoid muscle
47
Jugular Vein Pressure (physiology)
 Reflects the right side of the heart  Assess filling pressure and volume status  Volume and pressure increases when right side of heart fails to pump efficiently  JVP gives information about the right side of the heart because no cardiac valve exists to separate superior vena cava from right atrium  Empties unoxygenated blood directly into superior vena cava  Two jugular veins present on each side of neck.  Internal and external
48
JVP (how to assess)
 Position head of the bed 30°, or when you see pulsations  Turn the patient’s head lightly to the left, then the right, and identify the external jugular vein on each side.  Focus on the internal jugular venous pulsations on the right, transmitted from deep in the neck to the overlying soft tissues.  Inspect for pulsations of internal jugular veins in area of suprasternal notch or around origin of sternomastoid muscle around clavicle.  Distinguish internal jugular vein pulsation from that of carotid artery
49
JVP Abnormal
JVP: >3 cm above the sternal angle, or more than 8 cm in total distance above the right atrium, is considered elevated above normal  An elevated JVP correlates with both acute and chronic heart failure.  Elevated JVP: tricuspid stenosis, chronic pulmonary hypertension, superior vena cava obstruction, cardiac tamponade, and constrictive pericarditis
50
Ascultation (Heart sounds)
 Patient supine  Follow a “Z” pattern  Begin with diaphragm of stethoscope  Use bell of stethoscope for bruits  Identify S1 and S2  Determine if there are abnormal heart sounds  S3 or S4  Are the sounds regular or irregular  Assess for a pulse deficit  Apical and radial pulse rates should match
51
Palpation (Apical pulse)
Palpable in about half of adults  Not palpable in obese or people with thick chest walls  High cardiac output states  Apical impulse increase in amplitude and duration  Anxiety, fever, hyperthyroidism, anemia  Displaced to the left in heart failure
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Auscultation (carotid cartery)
Use the bell of stethoscope  Better for higher grade stenosis  Have client take a breath, exhale, and hold it briefly for < 10 seconds while you listen  Listening for Bruits  Place the bell of stethoscope near upper end of thyroid cartilage, below the angle of the jaw https://medical-dictionary.thefreedictionary.com/_/viewer.aspx?path=MosbyMD&name=carotid- bruit.jpg&url=https%3A%2F%2Fmedical-dictionary.thefreedictionary.com%2Fcarotid%2Bbruit

NUR 502 (13 decks)

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